About 1.3 million Americans – most of them women – have rheumatoid arthritis (RA), a crippling joint disease. There’s no known cause or cure, but genetically engineered drugs offer promising pain relief in the field of rheumatoid arthritis treatment. Here, Australian author Karen Ager recounts her 30-year battle against RA and what helps her cope…

Lazing on an Australian beach when she was 15, Karen Ager suddenly felt a sharp pain in her right side. It felt, she says, like a hot dagger piercing her flesh and twisting into her hip.

Her cousin carried her home. Her mother tucked her into bed with a kiss and an aspirin.

Ager felt fine the next morning, and for the next two years, the family shrugged off incidents that, in retrospect, signaled trouble. She couldn’t unload the dishwasher without dropping a plate. She fell so often that her clumsiness became a family joke.

But soon after graduating high school, she woke up unable to move. Every joint from her ankle to her jaw throbbed mercilessly. A doctor finally put a name to her condition: rheumatoid arthritis (RA).

The book traces her struggles to find love and success as an elementary-school teacher in New York City while secretly fighting her disease.

She describes years of often-futile therapy that left her in a wheelchair – and the rheumatoid arthritis treatment that got her up and walking pain-free, overnight.

In this exclusive Lifescript interview, Ager reveals how her experience can help other RA sufferers – and anyone coping with a chronic condition.

Why did you write the book Enemy Within?People with rheumatoid arthritis need to unburden themselves of the secret of the illness and reach out to [those] around them. I hoped that I could help others reach out and find support.

Why did you keep your illness secret from almost everyone?When you’re chronically ill, you lose your self-esteem [and] dignity sometimes. I did, especially when I was in my early 20s and dependent on my mum for getting dressed and going to the bathroom.

This wasn’t how my life was supposed to be. I felt embarrassed. I just didn’t want people to know.

At the time, your parents’ marriage was ending. Do you think stress played a role in your illness?There’s a huge connection for me. People might have a genetic predisposition to RA, but it can take an event to trigger the illness.

I think I had a couple of triggers: One was glandular fever and the other was my parents’ breakup.

You were finally diagnosed with rheumatoid arthritis at 17. What did the doctor say the future held?Three words: progressive, degenerative, incurable.

How did you react?I did what teenagers are programmed to do in matters of mortality, responsibility and the future: I blocked it out. I chose to treat it as a minor inconvenience, like a bout of influenza.

Did they help?They masked the pain, but they didn’t control the disease or stop further joint damage.

As your condition worsened, did your mother urge you to try natural remedies?Yes, and she wasn’t alone. [About] 90% of people with arthritis turn to alternative remedies at some point.

She took you to a clinic in England. What happened there?I naively played around with drinking apple cider vinegar. They said back then that people with rheumatoid arthritis had high levels of acid in their bodies, and this was supposed to neutralize it.

I drank molasses too. And I gave up all my conventional medicines. It took about three months to wean me off those. I thought I was improving, but I really wasn’t.

Did you switch back to drugs for your rheumatoid arthritis treatment?I tried to stick with natural remedies for a few more months. But I became totally dependent on my mother. I ended up in a wheelchair. We were living in a four-story walkup so I couldn’t go out.

I had no strength in my hands – I couldn’t even lift a cup to my mouth. I couldn’t bathe myself [or] work. I just couldn’t function. I could feel the damage happening to my body.

So, finally, I made the decision to go back on rheumatoid arthritis medications.

How did your disease affect your romantic relationships?In the beginning, it influenced my choice of men. In my first serious relationships, I found myself in abusive situations: one was physical and the other was emotional abuse.

Researching the book, I found disabled women are more likely to be victims of domestic violence.

I felt like I was damaged goods.

Your first boyfriend beat you so viciously that you ended up in intensive care. How did that affect your illness?It was a terrible cycle. You’re in a bad relationship, plus you have a disability, so it’s harder to leave. But RA also forced me to reflect on myself – what I was doing right and where I was feeling strong.

It made me more aware of what I wanted and what I could get.

[So I left the relationship] and now I’m happily married.

In July 2001, your doctor offered you infliximab, a genetically engineered biologic that had just come on the market for rheumatoid arthritis treatment. Why were you reluctant to try it?A lot of fear. It was delivered by infusion [administered through a vein], and they didn’t really understand its side effects [which include upper respiratory tract and urinary tract infections, rashes, back pain and nausea].

What persuaded you to go ahead?My flares were becoming more frequent. I hadn’t had a pain-free day in 20 years.

How was the first treatment?The infusion took about two hours. I just kept thinking how happy I would be if this worked out well for me.

As the medication dribbled into my vein, I felt more confident. In the morning, I woke up and felt great.

No pain?Almost none. A few days later, I went home to Australia on a long-haul flight, and for the first time, I could lift my own bag overhead. That was amazing.

Was this the miracle cure?No, my body gradually got used to [the drug], so I had to have more frequent infusions. Then I had to switch drugs. I’m on my fourth biologic now, and it’s not fully controlling my illness.

Do you follow a special diet?I take omega-3s, about six fish oil tablets a day. I avoid breads and cakes, because I think they can cause inflammation. I eat mainly fresh food and foods high in antioxidants – lots of blueberries and blackberries.

What about exercise?That’s a big issue for people with RA. It’s hard to exercise when pain and fatigue build up.

Right now, I work on my balance. It’s important for me because my feet are often sore. It’s as simple as standing on a yoga mat and lifting one leg up or doing squats.

How do you manage stress?I like to connect with nature. That can be simple, even in New York City. When I’m walking my dog, I just look up at a tree or the sky.

On your Karen and Arthritis website, you’ve posted 12 steps for coping with an illness like yours. No. 1 is “Cry.” Why?It’s the beginning of the process. When you’re diagnosed [with rheumatoid arthritis], you go through a grieving process. You lose a lot. You’re not able to do the things you used to do. You need to feel that sadness and let it out. Otherwise, you become numb and the sadness stays inside you.

Why is No. 2 “Be angry”? It can be an important part of healing. When Christina Applegate was diagnosed with breast cancer, she was applauded for saying it’s OK to be angry. It was very honest.

You also advise people to do random acts of kindness. How do those help?It makes you feel so good to do something for someone else. It can be as simple as writing a thank-you note or holding a door open. I try to do one small thing for someone every day.

You also encourage patients to set goals. Why is that important?Sometimes, you don’t feel like getting out of bed. Even if the goal is as small as getting up, getting dressed and going for a walk around the block, it’s a start.

What are your goals now?To change public awareness about rheumatoid arthritis so everyone understands that it’s not just an old person’s disease.

To make a difference for people who have RA.

What do you know now about rheumatoid arthritis that you wish you’d known when you were 17?You can always hold on to your dreams, despite RA. You can always have hope.

What’s Your Inflammation IQ?Inflammation has become a hot topic over the last few years. The latest scientific research indicates that inflammation is behind more than 80% of the conditions we suffer from – everything from arthritis to heart disease. Dr. Mark Hyman, author of The UltraSimple Diet, agrees that inflammation leads to a host of health problems. Fighting it can get you on track to a healthier, happier life. Take this inflammation quiz and find out how much you may already know.

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